大面积脑梗死38例临床分析

目的探讨大面积脑梗死的病因、临床特点、治疗及预后的关系。方法回顾性分析2007年1月～2009年12月笔者所在科室收治的38例大面积脑梗死患者的临床表现、头颅影像学检查结果及治疗和预后资料。结果 38例患者中,心源性栓塞12例,动脉源性栓塞7例,颅内动脉狭窄3例,来源不明的或非栓塞性16例。30例采用内科保守治疗,好转27例,死亡3例,均为严重脑疝患者。8例因颅内高压进行性加重转外科行开颅减压术,好转7例,死亡1例。结论大面积脑梗死发病突然,病情严重,并发症重,致残、致死率高,急性期治疗的关键是控制颅内压,降低脑水肿,防止脑疝形成,促进病变脑组织功能恢复。对内科治疗效果差者应尽早转外科行减压术,以改善预后。

Clinical Analysis on 38 Cases of Massive Cerebral Infarction

Objective To explore the causes,clinical features,and relation between treatment and prognosis of massive cerebral infarction.Methods 38 patients with MCI were retrospectively analyzed in clinical manifestations,cerebral imaging findings,treatment and prognosis.Results There were 12 cases of cardiac embolism,7 cases of arterial embolism,3 cases of intracranial arterial stenoses,and 16 cases of undetermined source and non-embolic disorders among the 38 patients.28 cases received the conservative treatment,among whom 25 cases recovered and 3 cases died of serious cerebral hernia.8 cases following progressive intracranial hypertension implemented decompressive craniectomy while 7 cases recovered and 1 case died.Conclusion MCI features include sudden onset,poor condition,severe complication,high rate of disability and fatality.The key of treatment at acute stage is to control the intracranial pressure,reduce hydrocephalus,avoid the occurrence of cerebral hernia and promote the function recovery of lesions.Patients with poor effect of medical treatment should be transferred to surgery system for decompressive craniectomy to improve the prognosis.